Table 3.
Efficacy of interventions for reducing symptoms of depression in subgroups of people with dementia without a diagnosis of major depressive disorder
| Intervention v usual care | Studies in pairwise treatment comparison (participant*) | Network meta-analysis | Meta-analysis† | |||||
|---|---|---|---|---|---|---|---|---|
| SMD (95% CrI) | SMD re-expressed as MD on CSDD (95% CrI) | Probability of MD >0.4 SDs‡ (%) | SMD (95% CrI) | SMD re-expressed as MD on CSDD (95% CrI) | Probability of MD >0.4 SDs‡ (%) | |||
| Studies enrolling participants with mild or moderate severity dementia (111 studies) | ||||||||
| Cognitive stimulation34 45-48 50-54 56 | 11 (765) | −0.51 (−0.80 to −0.19) | −2.59 (−4.10 to −0.98) | 78.1 | −0.63 (−1.01 to −0.25) | −3.21 (−5.17 to −1.29) | 88.1 | |
| Cognitive Stimulation+cholinesterase inhibitor | - | −2.37 (−3.95 to −0.73) | −12.10 (−20.16 to −3.70) | 98.8 | - | - | - | |
| Exercise+social interaction+cognitive stimulation63 | 1 (14) | −2.40 (−3.80 to −0.98) | −12.25 (−19.36 to −4.99) | 99.8 | −2.41 (−3.39 to −1.42) | −12.29 (−17.30 to −7.25) | 100 | |
| Massage and touch therapy64-66 | 3 (219) | −1.78 (−2.44 to −1.07) | −9.06 (−12.45 to −5.44) | 100 | −1.76 (−2.46 to −1.07) | −9.01 (−12.55 to −5.44) | 100 | |
| Occupational therapy74 76 78 | 3 (282) | −0.63 (−1.20 to −0.10) | −3.24 (−6.10 to −0.49) | 80.7 | −0.71 (−1.36 to −0.05) | −3.62 (−6.96 to −0.26) | 82.2 | |
| Psychotherapy+reminiscence therapy+environmental modification79 | 1 (51) | −0.99 (−2.20 to 0.16) | −5.03 (−11.21 to 0.80) | 84.7 | −0.99 (−1.53 to −0.45) | −5.05 (−7.84 to −2.32) | 98.5 | |
| Reminiscence therapy22 82 83 85 88 89 92 | 9 (1043) | −0.55 (−0.91 to −0.20) | −2.81 (−4.62 to −1.02) | 81.1 | −0.51 (−0.90 to −0.12) | −2.60 (−4.62 to −0.62) | 70.9 | |
| Studies at low risk of bias from missing data (101 studies) | ||||||||
| Cognitive stimulation34 45 47 50 51 55 56 | 7 (248) | −0.92 (−1.34 to −0.51) | −4.70 (−6.82 to −2.59) | 99.4 | −1.14 (−1.65 to −0.62) | −5.80 (−8.45 to −3.18) | 99.7 | |
| Cognitive stimulation+cholinesterase inhibitor | - | −2.47 (−4.24 to −0.64) | −12.62 (−21.62 to −3.27) | 98.4 | - | - | - | |
| Cognitive stimulation+exercise+social interaction63 | 1 (14) | −2.38 (−3.90 to −0.86) | −12.14 (−19.89 to −4.41) | 99.4 | −2.41 (−3.40 to −1.42) | −12.29 (−17.39 to −7.23) | 100.0 | |
| Exercise57 59 62 | 3 (304) | −0.55 (−1.10 to −0.01) | −2.80 (−5.62 to −0.06) | 71.8 | −0.71 (−1.44 to 0.03) | −3.61 (−7.34 to 0.14) | 79.2 | |
| Massage and touch therapy65 66 | 2 (85) | −1.40 (−2.38 to −0.42) | −7.15 (−12.15 to −0.17) | 97.7 | −1.41 (−2.36 to −0.42) | −7.18 (−12.07 to −2.17) | 97.7 | |
| Multidisciplinary care71 72 | 2 (93) | −1.19 (−2.07 to −0.31) | −6.05 (−10.56 to −1.56) | 95.8 | −1.33 (−2.30 to −0.33) | −6.81 (−11.73 to −1.68) | 96.5 | |
| Music therapy+occupational therapy93 | 1 (119) | −0.41 (−1.65 to 0.79) | −2.10 (−8.42 to 4.05) | 51.2 | −0.42 (−0.78 to −0.06) | −2.13 (−3.96 to −0.31) | 53.7 | |
| Music therapy94-98 | 5 (383) | −0.52 (−0.98 to −0.04) | −2.66 (−4.99 to −0.21) | 69.3 | −0.34 (−1.30 to 0.62) | −1.73 (−6.65 to 3.15) | 44.9 | |
| Psychotherapy+reminiscence therapy+environmental modification79 | 1 (51) | −0.99 (−2.20 to 0.30) | −5.06 (−11.24 to 1.52) | 82.2 | −0.99 (−1.53 to −0.45) | −5.06 (−7.83 to −2.31) | 98.4 | |
| Reminiscence therapy14 22 80 82 84 89 90 | 7 (432) | −0.37 (−0.84 to 0.09) | −1.90 (−4.29 to 0.48) | 46.2 | −0.52 (−1.01 to −0.01) | −2.66 (−5.18 to −0.06) | 68.2 | |
| Studies using standard criteria for dementia diagnosis (136 studies) | ||||||||
| Cognitive stimulation45-47 49-53 55 56 | 10 (712) | −0.83 (−1.17 to −0.51) | −4.24 (−5.99 to −2.58) | 99.4 | −0.91 (−1.31 to −0.53) | −4.66 (−6.70 to −2.69) | 99.5 | |
| Cognitive stimulation+cholinesterase inhibitor | - | −2.41 (−4.02 to −0.88) | −12.31 (−20.49 to −4.47) | 99.5 | - | - | - | |
| Cognitive stimulation+exercise+social interaction63 | 1 (14) | −2.42 (−3.79 to −1.05) | −12.33 (−19.30 to −5.34) | 99.8 | −2.41 (−3.39 to −1.42) | −12.31 (−17.33 to −7.27) | 100.0 | |
| Massage and touch therapy64 66 | 2 (199) | −2.14 (−2.94 to −1.37) | −10.90 (−14.98 to −6.97) | 100 | −2.15 (−2.93 to −1.36) | −10.98 (−14.97 to −6.97) | 100.0 | |
| Multidisciplinary care68 70 71 73 | 4 (679) | −0.74 (−1.27 to −0.23) | −3.76 (−6.50 to −1.16) | 91.1 | −0.78 (−1.34 to −0.20) | −3.97 (−6.85 to −1.01) | 90.2 | |
| Occupational therapy74 75 78 | 3 (349) | −0.84 (−1.46 to −0.22) | −4.29 (−7.45 to −1.11) | 92.4 | −1.02 (−1.78 to −0.27) | −5.22 (−9.09 to −1.39) | 94.7 | |
| Reminiscence therapy22 80 82 83 85 90-92 | 8 (1050) | −0.42 (−0.79 to −0.06) | −2.15 (−4.05 to −0.29) | 55.6 | −0.37 (−0.76 to 0.01) | −1.90 (−3.90 to 0.08) | 44.0 | |
CSDD=Cornell scale for depression in dementia; MA=pairwise meta-analysis; MD=mean difference; CrI=credible interval; SMD=standardised mean difference.
*
Sample sizes adjusted for clustering effect, when appropriate.
†
Pairwise meta-analysis.
‡
Minimum clinically important difference estimated to be 2.0 at 0.4 standard deviations (SDs) and 2.5 at 0.5 SDs.